Transitional Care
Bridging the gap between hospital and home to maximise recovery and promote independence LCHS is working with partners to develop a range of reablement services to promote faster recovery from illness, prevent admission into acute hospital or residential care, support timely discharge from hospital and maximise independent living.
We wish to make your stay with us as pleasant as possible and aim to return you to your normal place of residence as soon as you become well enough and no longer require transitional care.
Our aim is for you to be with us for a maximum of up to 21 days depending on your rehabilitation journey. Together we will be aiming to return you to your usual place of residence as soon as possible. This is for your safety as well as other residents and staff. This will not have an impact on your rehabilitation journey.
Your Home First Plan is
designed with you to support you to return home safely. If you need assistance
from your family and friends to complete the Plan, then this can be arranged.
This may have already commenced
in another setting, such as hospital.
Your Home First plan will
include an assessment and will clarify your personal goals to help us and you
to identify your current and future needs. It may involve working with
colleagues from other organisations to support you and help you decide what your
Home First Plan is.
This may include considering longer term health and care needs that cannot be met in your own home.
The team looking after you will discuss with you the date they expect you will be able to leave the transitional care bed – this is called a predicted date of discharge – and will keep you informed should this date need to change, if goals can be achieved earlier, then this will be brought forward.
We will assess the things you may need upon discharge as soon as possible after you are admitted; to help put them in place with minimal delay. If you need some extra support, the teams will meet with you to talk about what options are available and make a plan that will best meet your needs. We do expect you and your family and/or representatives to work with us to ensure you are able to be discharged on the date planned.
If at any time you are unsure about your care or your discharge plan please speak to the team who will be happy to help you.
Address: Lincolnshire Community Health Services NHS Trust, Beech House, Witham Park, Waterside South, Lincoln, LN5 7JH
Telephone: 01522 459790
Email: LHNT.homefirst@nhs.net
